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Introduction: Little is known about the effects of tube-assisted feeding (TF) on growth in children who undergo biventricular repair. We sought to evaluate the relationship between TF exposure and longitudinal growth in this population. Methods: Our retrospective cohort study included patients with complex biventricular repair, defined by risk adjustment for congenital heart surgery (RACHS)-1 score ≥3, with initial intervention before age 4 years from 1999-2009. Patients with known genetic syndromes were excluded. TF exposure was defined as nasogastric or gastrostomy tube feeds within the first 30 days of discharge. Height and weight were collected from clinic visits for each year of life from age 2-12. To evaluate the relationship between TF and longitudinal growth, mixed-effects multivariable fractional polynomial regression models were used to account for variability in outcomes both across patients as well as at each age group. TF and non-TF groups were compared using models for height, weight, and BMI z-score, adjusting for demographic factors, surgical complications, and medical comorbidities. Results: 152 patients met inclusion criteria, 43 (28%) of whom were in the TF group. Though the two groups did not differ in basic demographic or surgical characteristics, TF was associated with higher rates of surgical complications and medical comorbidities. Longitudinal growth was followed up to a median of age 6 years (range 4-12) with a mean of 5.1±2.0 data points in the TF group and age 7 years (range 3-12) with 5.1±2.6 data points in the non-TF group. TF patients did not differ from non-TF patients in terms of height or weight z-scores. However, BMI z-score was on average 0.41 standard deviations lower in TF patients than in non-TF patients (-0.41, 95% CI: [-0.76, -0.057], p=0.023) (figure). Conclusions: In children with complex biventricular repair at a young age, early TF is associated with decreased BMI in early to late childhood, independent of medical complexity. [ABSTRACT FROM AUTHOR]